Petroleum and Medicare: A Crisis In The Making?
"Our current highly interlinked economic, environmental, and sociopolitical systems represent complex systems that were optimized for a world of cheap and plentiful oil, which makes them inherently less resilient to the external shock that is coming and more vulnerable to disruption." (American Journal of Public Health 101.9 (2011): 1560–1567)
Let's talk about vulnerability...
Specifically, that of the Canadian healthcare system.
You might say, "Ola, what are you on about? Medicare may need quite a bit of reform but, relative to that of other nations, I wouldn't consider it that vulnerable...matter of fact, it just might be the Gold standard the world over... you should know better."
Ok...you might not say that.
What I am talking about relates to issues the health delivery eco-system faces in the event of a downturn in petroleum supply. The sector does not influence oil prices nor does it dictate supply levels, yet, its dependence on a nonrenewable resource is pervasive. Inputs derived from petroleum are fundamental to the day to day running of many healthcare service providers, with uses ranging from the fuel that transports staff, patients and emergency services from place to place to the manufacture of plastics, pharmaceuticals and other medical supplies. A downturn would motivate a sector wide transition and such an event would leave service providers and health policy officials in a state of volatility. One also has to consider that any new technological innovations designed to mitigate such supply disparities are unlikely to outpace demand or even prove cost effective.
Stakeholder complacency at the moment may stem from game changing advances in horizontal drilling, micro-seismic imaging and hydraulic fracturing, nonetheless long run uncertainties reflect the need for public health administrators, policy makers and concerned members of the public to identify future concerns that could disrupt healthcare delivery. In order to fully ascertain the scope of vulnerability, stakeholders need to be aware of healthcare's systemic dependencies in relation to petrochemical usage. In this blog, I will be exploring a couple of these dependencies and assessing the potential implications and consequences a petroleum supply shift would inflict on the system.
Points of Exposure: Transportation
Let’s begin by exploring the commute patterns of the healthcare workforce. According to Statistics Canada, in 2016 the Healthcare and Social Assistance sector employed 233,900 people, the first assumption to make here is that majority of these individuals work commutes involve using vehicles that utilize gasoline.
The second will be that (excluding weekends and holidays) Canadian health professionals round trip to work 262 times in a year, so by those calculations approximately 123 million yearly trips. Another dimension to this concerns trips made by and/or involving patients, it is hard to even try and quantify how many ambulance runs, primary care trips, trips involving screening and testing, routine checkups, surgical and therapy related trips go down on a daily basis. Other additional aspects to consider involve the transport of medical supplies, off-site activities, hospice and home care and so on.
The most visible change would be at the pump. While an increase in fuel prices would likely encourage staff and patients to increase their usage of biking, public transit and other alternative means like ride-sharing, this would only be effective in areas with the infrastructure ready to handle the transition.
Far flung rural areas or places with underdeveloped transport networks might begin to see staffing shortages as micro economic considerations influence the location preferences of healthcare staff workforce.Departments, due to diminishing supply reserves and the rising costs needed to procure medical supplies might roll back their services in certain geographic locations. Affordability for secondary, preventative or screening services would likely take a dip for patients living in these areas and the ability to effectively monitor public health issues like outbreaks or epidemics is hindered.
In the next blog, I will try to identify other points of exposure present and explore further implications and other considerations.
Survey of Commercial and Institutional Energy Use, 2014 (http://www.statcan.gc.ca/daily-quotidien/160916/dq160916c-eng.htm)
Commercial and Institutional Building Energy Use, 2003 http://oee.nrcan.gc.ca/corporate/statistics/neud/dpa/data_e/Cibeus2/CIBEUS2_ENG.pdf
Geographies of health and development101648139 - NLM Catalog Result - NCBI." http://www.ncbi.nlm.nih.gov/nlmcatalog/101648139. Accessed 23 Jul. 2017
Employment by industry (http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/econ40-eng.htm)
Prescription medication use by Canadians aged 6 to 79 (http://www.statcan.gc.ca/pub/82-003-x/2014006/article/14032-eng.htm)
Schwartz, Brian S. et al. “Public Health and Medicine in an Age of Energy Scarcity: The Case of Petroleum.” American Journal of Public Health 101.9 (2011): 1560–1567. PMC. Web. 26 July 2017.
Hess, Jeremy et al. “Petroleum and Health Care: Evaluating and Managing Health Care’s Vulnerability to Petroleum Supply Shifts.” American Journal of Public Health 101.9 (2011): 1568–1579. PMC. Web. 26 July 2017.
Peak oil and public health: preparing healthcare for another kind of transition…(https://epianalysis.wordpress.com/2011/08/23/peakoil/)